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Hip Pain - Iliopsoas Tendonitis and Iliopsoas Syndrome
By Brad Walker

Iliopsoas Tendonitis and Iliopsoas Syndrome are conditions that affect the iliopsoas muscle located in the anterior region (or front) of the hip. (Due to the over-whelming response I received from last month's article, Piriformis Syndrome, I've decided to stick with conditions that affect the hip area. Apparently, there are a lot of people suffering with hip pain.)

What are Iliopsoas Tendonitis and Iliopsoas Syndrome?
Technically, they are two separate conditions, but it's not uncommon to hear the term iliopsoas tendonitis or iliopsoas syndrome being used to describe the same thing.

Iliopsoas tendonitis refers to inflammation of the iliopsoas muscle and can also affect the bursa located underneath the tendon of the iliopsoas muscle. Whereas iliopsoas syndrome refers to a stretch, tear or complete rupture of the iliopsoas muscle and / or tendon.

Anatomy of the Hip Joint
Iliopsoas Muscle Picture The iliopsoas muscle is actually made up of two separate muscles located in the anterior (or front) of the hip area.

In the diagram to the right you can see the Iliacus labeled on the left and the Psoas labeled on the right. These two muscles are responsible for lifting the upper leg to the torso, or flexing the torso towards the thigh (as in a sit-up).

Although the two muscles start at different points (the psoas originates from the spine, while the iliacus originates from the hip bone) they both end up at the same point; the upper portion of the thigh bone. It is at this point; the insertion, that most injury occurs.

What Causes Iliopsoas Tendonitis and Iliopsoas Syndrome?
Iliopsoas tendonitis is predominately caused by repetitive hip flexion or overuse of the hip area, resulting in inflammation. Iliopsoas syndrome, on the other hand, is caused by a sudden contraction of the iliopsoas muscle, which results in a rupture or tear of the muscle, usually at the point where the muscle and tendon connect.

Athletes at risk include runners, jumpers and participants of sports that require a lot of kicking. Also at risk are those who participate in strength training and weight lifting exercises that require a lot of bending and squatting.

Symptoms!
Pain and tenderness are common symptoms of both conditions; however the onset of pain associated with iliopsoas tendonitis is gradual and tends to build up over an extended period of time, whereas the pain associated with iliopsoas syndrome is sudden and very sharp.

Treatment!
Iliopsoas tendonitis and iliopsoas syndrome is a soft tissue injury of the iliopsoas muscle and therefore should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regime should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis.

It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The application of heat and massage is one of the most effective treatments for removing scar tissue and speeding up the healing process of the muscles and tendons.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.

For a complete and comprehensive article on the treatment of soft tissue injuries, please visit http://www.thestretchinghandbook.com/archives/sports-injuries.htm.

Prevention!
There are a number of preventative techniques that will help to prevent both iliopsoas tendonitis and iliopsoas syndrome, including modifying equipment or sitting positions, taking extended rests and even learning new routines for repetitive activities. However, there are four preventative measures that I feel are far more important and effective.

Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the hip area, which will result in a lack of oxygen and nutrients for the muscles. This is a sure-fire recipe for a muscle or tendon injury.

Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity. For a detailed explanation of how, why and when to perform your warm up, visit http://www.thestretchinghandbook.com/archives/warm-up.htm.

Secondly, rest and recovery are extremely important; especially for athletes or individuals whose lifestyle involves strenuous physical activity. Be sure to let your muscles rest and recover after heavy physical activity.

Thirdly, strengthening and conditioning the muscles of the hips, buttocks and lower back will also help to prevent iliopsoas tendonitis and iliopsoas syndrome.

And fourthly, (and most importantly) flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. When this happens, strains, sprains, and pulled muscles occur.

To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine. I've included an effective iliopsoas stretch below, but for an easy-to-use, quick reference guide of more than 100 clear photographs of every possible sports related stretch, for every major muscle group in your body, get a copy of The Stretching Handbook. If you're interested in stretches for the hips, buttocks and lower back, The Stretching Handbook has detailed photographs of 18 different stretches you can do. Learn more about The Stretching Handbook here.

Stretch taken from Stretching Handbook
Kneel on one foot and the other knee. If needed, hold onto something for balance and then push your hips forward.


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